Erythema | University of Maryland Medical Center Medications, such as birth control pills; sulfa drugs Who is Most At Risk? Men are at greater risk than women for erythema multiforme. Women are at greater risk than men for erythema nodosum. Frequent or excessive sun exposure increases the risk for erythema multiforme. People between 20 to 30 years of age are at greater risk of erythema nodosum. People with a family history of skin conditions have a greater chance of developing either erythema multiforme or erythema nodosum.

Signs and Symptoms Fatigue, fever, and itching (before lesions appear) Sudden outbreak of spots, bumps, and lesions (usually on knees, elbows, palms, hands, and feet) Target lesions (spots surrounded by rings of normal and red skin, looking like a target) Erythema infectiosum (caused by a virus and known as fifth disease), rash on face and arms lasting about 2 weeks Erythema nodosum: Fatigue, flu-like symptoms (before lesions appear) Clusters of nodules (small round masses) and lesions on shins, forearms, thighs, and trunk Red, painful lesions become soft and bluish, and fade to yellow and brown Joint pain Arthritis Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), the most severe forms of erythema multiforme, have a different set of symptoms. Target lesions on the trunk, hacking cough, fever, and blisters around the mouth, eyes, nostrils, and anal and vaginal areas are the key symptoms of SJS.

A person with TEN will have symptoms of SJS that worsen to include peeling and detachment of the skin, pus-like infections, fluid loss, and even death. What to Expect at Your Doctor's Office Your doctor will perform a physical exam and may order a skin biopsy, throat culture, blood test, or x-ray to determine the type of erythema. These tests also may reveal any infections or medications that are contributing to symptoms. Treatment Options Prevention Treat underlying diseases and avoid known triggers (certain medications, for example). It is also important to avoid the sun when taking certain medications. Treatment Plan Your doctor will treat any underlying diseases, stop any drugs that may contribute to symptoms, and take steps to control your current symptoms. Mild cases may not require treatment. Bed rest and medication may be necessary for more severe cases. Drug Therapies Antihistamines for itching Antibiotics.

If you have an infection, though research suggests many cases of erythema can be resolved without antibiotics Antiviral medications such as acyclovir and valacyclovir, if you have a virus Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) Burrow's compresses, a solution used to soothe skin conditions, particularly blisters Corticosteroids, applied to the skin (topically); corticosteroids may also be taken orally to reduce symptoms of erythema nodosum Intravenous immunoglobulin, used experimentally for SJS and TEN Photomodulation therapy, use of a light-emitting diode to accelerate the resolution of erythema Complementary and Alternative Therapies To treat erythema, you must treat the underlying cause. It is important to get a proper diagnosis from your doctor before using complementary and alternative therapies (CAM). Not all CAM therapies are appropriate for all people, and some may interact with conventional medicines or therapies. You should use CAM therapies only under the guidance of a physician. Some CAM therapies may be used to: Reduce inflammation Prevent infections Nutrition Antioxidants are molecules that scavenge free radicals (chemicals that can damage cells).

Antioxidants also may protect skin against damage caused by ultraviolet (UV) sun rays. The following antioxidants have been shown to protect skin against damage in scientific studies: Beta-carotene and other carotenoids (up to 300 IU per day for beta-carotene): Beta-carotene is often used as a standard treatment for sun sensitivity, although studies have been mixed. In one trial, though, 20 healthy subjects received either carotenoids alone, mainly from beta-carotene, or carotenoids plus vitamin E. Both groups improved significantly, but vitamin E did not appear to add any benefits. Scientists think the protective effect of beta-carotene comes from its antioxidant effect, so it's possible other antioxidants may also help protect skin from damage. Vitamin B6 (100 mg per day for 3 months): Some case reports suggest that vitamin B6 can help reduce the reaction to sunlight. You should only take high doses of vitamin B6 under a doctor's supervision, because of the risk of side effects.

Vitamin B6 can interfere with Amiodarone (Cordarone), Phenobarbital (Luminal), Phenytoin (Dilantin), and possibly Levodopa. Speak with your physician if you are taking any of these medications. Vitamin C (1 to 3 g per day, lower dose if diarrhea develops): Vitamin C is an antioxidant, so it may provide some protection against skin damage from sunlight. Vitamin C can negatively impact certain health conditions, and can interfere with some medications. Speak with your physician. Vitamin E: Vitamin E is also an antioxidant, and a few studies have shown that it can offer protection from sun damage to skin when taken with vitamin C (but not alone). However, other studies have not found the same results. Vitamin E may interact with certain medications, including but not limited to, blood-thinning medications, such as warfarin (Coumadin). It may also have negative effects on people with bleeding disorders, head and neck cancers, Retinitis Pigmentosa, and other conditions. Vitamin D: In animal studies, vitamin D helped protect against damage from UVB rays. It is not clear yet whether vitamin D supplements may protect humans in the same way.

Vitamin D can interact with some medications, including but not limited to, Digoxin and Verapamil. It may also have a negative impact on some health conditions. Speak with your physician. Other Supplements Melatonin: Applying melatonin topically (either alone or in combination with vitamin E) seems to offer some protection against sunburn in healthy people, but it is not known whether melatonin also lessens effects in people prone to erythema. Zinc: Zinc is necessary for healthy skin and was used in a study along with other prescription medications as a treatment for a severe form of erythema multiforme similar to TEN. In the study, 5 out of 8 people treated with zinc showed a benefit. Because high doses of zinc can be dangerous, many doctors suggest doses below 50 mg per day. Talk to your doctor to determine which dose is right for you. Zinc can interact with certain antibiotics, Cisplatin, Amiloride, and Penicillamine (used for Wilson syndrome and Rheumatoid arthritis). Herbs Flavonoids: Some of these plant-based antioxidants may protect skin from sun damage in healthy people.

In one study, German researchers found that drinking high flavonol cocoa offered protection from the sun (the cocoa used was a special formulation that is not available commercially). In another study, pomegranate fruit extract helped protect skin cells in a test tube from UV light. It is not yet known whether taking the extract would provide any benefit. However, adding fruits and vegetables to your diet to eat more flavonoids may help. You can also take these flavonoids in dried extract form. Speak with your physician first, since certain flavonoids can interact with prescription medications: Catechin, quercetin, hesperidin, and rutin. Rose hips (Rosa canina) are also high in flavonoids and may be used as a tea. Drink 3 to 4 cups per day. Hesperidin methyl chalcone is a water-soluble form of quercetin that may act as an antihistamine. Green tea (Camellia sinensis) may also protect against erythema caused by UV light because it contains antioxidants. Herbs traditionally used topically to heal damaged skin, promote lymph circulation, and possibly treat the underlying cause of various skin conditions may be helpful.

You should check with your doctor before using any of these remedies. Some examples include: Aloe vera: Used topically for skin inflammation. One study found that aloe vera displayed anti-inflammatory effects superior to 1% hydrocortisone gel. Burdock root (Arctium lappa): Used topically for skin inflammation and wound healing. Never apply to an open wound. Calendula (Calendula officinalis): Used topically for burns, wounds, and other skin conditions. Never apply to an open wound. Goldenseal (Hydrastis canadensis): Used for infections, including those causing skin lesions. Lemon balm (Melissa officinalis): Can be applied to HSV lesions as a cream or a wash. Sage extract: Applied topically to reduce inflammation. In one study, sage extract significantly reduced the ultraviolet induced erythema to a similar extent as hydrocortisone. Slippery elm (Ulmus fulva): Applied topically, in combination with goldenseal root. Never apply to an open wound. Yarrow (Achillea millefolium): Applied topically for skin inflammation and wound healing. Never apply to an open wound.

Homeopathy Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of erythema based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for an individual. Apis mellifica: For skin rashes that feel hot and dry and are sensitive to touch; may be accompanied by sore throat. Symptoms are relieved by cool drinks and baths and worsened by heat and warm liquids. This remedy is most appropriate for individuals who often feel sad, disappointed, or even depressed. They tend to cry easily, but may also be irritable and envious by nature. They are also not thirsty but may crave milk. Calendula: For burns and skin lesions that are fairly superficial. This remedy is often used after the acute phase of the skin condition has subsided to aid in complete recovery. Rhus toxicodendron: Used for blisters and vesicles accompanied by intense itching that worsens at night and improves with the application of heat.

This remedy is most appropriate for individuals who are generally restless and unable to get comfortable at night. Sulphur: For skin disorders that are accompanied by fever and intense itching. This remedy is most appropriate for individuals who are thirsty, irritable while sick, lazy, and messy under ordinary circumstances, and who describe a sensation of internal heat and burning. Symptoms tend to improve with open, cold air and worsen with warmth. Prognosis/Possible Complications When treated properly, signs and symptoms of erythema multiforme usually disappear within 4 to 6 weeks. Symptoms of erythema nodosum, however, may reappear for up to 2 years. Symptoms of SJS typically disappear in a month, but when the condition is not treated properly it may lead to blindness. Both SJS and TEN can cause death. If the drug causing either SJS or TEN is identified quickly, a person's chance of survival significantly improves. Following Up Your doctor will monitor fluid and electrolyte levels, protein loss, and any organ damage. People with erythema multiforme may need treatment in a hospital burn unit if 20% or more of their body is affected.

Special Considerations If a pregnant woman develops erythema infectiosum (fifth disease), the virus can infect the fetus and cause fetal anemia, heart failure, hydrops (collection of watery fluid), and even death. Studies have also shown that pregnancy may trigger erythema nodosum. Supporting Research Beers MH, Porter RS, et al. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006:1642-1644. Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, Mass: Integrative Medicine Communications; 2000:230-239, 253-263, 419-423. Bolognia: Dermatology. 3rd ed. St. Louis, MO: Elsevier Saunders; 2012. Chen CW, Tsai TJ, Chen YF, Hung CM. Persistent erythema multiforme treated with thalidomide. Am J Clin Dermatol.

2008;9(2):123-7. Dreher F, Denig N, Gabard B, Schwindt DA, Maibach HI. Effect of topical antioxidants on UV-induced erythema formation when administered after exposure. Dermatology. 1999;198(1):52-55. Dreher F, Gabard B, Schwindt DA, Maibach HI. Topical melatonin in combination with vitamins E and C protects skin from ultraviolet-induced erythema: a human study in vivo. Br J Dermatol. 1998;139(2):332-339. Eberlein-König B, Placzek M, Przybilla B. Protective effect against sunburn of combined systemic ascorbic acid (vitamin C) and d-alpha-tocopherol. J Am Acad Dermatol. 1998;38(1):45-48. Fuchs J, Kern H. Modulation of UV-light-induced skin inflammation by D-alpha-tocopherol and L-ascorbic acid: a clinical study using solar simulated radiation.

Free Radic Biol Med. 1998;25(9):1006-1012. Garcia-Doval I, LeCleach L, Bocquet H, Otero XL, Roujeau JC. Toxic epidermal necrolysis and Stevens-Johnson syndrome: does early withdrawal of causative drugs decrease the risk of death? Arch Dermatol. 2000;136(3):323-327. Garcia-Porrua C, Gonzalez-Gay MA, Vazquez-Caruncho M, et al. Erythema nodosum: etiologic and predictive factors in a defined population. Arthritis Rheum. 2000;43(3):584-592. Geria AN, Holcomb KZ, Scheinfeld NS. Necrolytic acral erythema: a review of the literature. Cutis. 2009;83(6):309-14. Grant WB, Holick MF. Benefits and requirements of vitamin D for optimal health: a review. Altern Med Rev.

2005 Jun;10(2):94-111. Review. Halliday GM, Yuen KS, Bestak R, Barnetson RS. Sunscreens and vitamin E provide some protection to the skin immune system from solar-simulated UV radiation. Australas J Dermatol. 1998;39(2):71-75. Hu JJ, Cui T, Rodriguez-Gil JL, et al. Complementary and alternative medicine in reducing radiation-induced skin toxicity. Radiat Environ Biophys. 2014;53(3):621-6. Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996:263-265. Katiyar SK. Skin photoprotection by green tea: antioxidant and immunomodulatory effects. Curr Drug Targets Immune Endocr Metabol Disord. 2003 Sep;3(3):234-42. Review. Katiyar SK, Matsui MS, Elmets CA, Mukhtar H.

Polyphenolic antioxidant (-)-epigallocatechin-3-gallate from green tea reduces UVB-induced inflammatory responses and infiltration of leukocytes in human skin. Photochem Photobiol. 1999;69(2):148-153. Khanna VJ, Shieh S, Benjamin J, et al. Necrolytic acral erythema associated with hepatitis C: effective treatment with interferon alfa and zinc. Arch Dermatol. 2000;136(6):755-757. Khoury JG, Goldman MP. Use of light-emitting diode photomodulation therapy to accelerate resolution of post-intense pulsed light (IPL) erythema. J Cosmet Dermatol. 2008;7(1):30-4. Lee J, Jiang S, Levine N, Watson RR. Carotenoid supplementation reduces erythema in human skin after simulated solar radiation exposure. Proc Soc Exp Biol Med. 2000;223(2):170-174. Martinez AE, Atherton DJ.

High-dose systemic corticosteroids can arrest recurrences of severe mucocutaneous erythema multiforme. Pediatr Dermatol. 2000;17(2):87-90. Mert A, Kumbasar H, Ozaras R, Erten S, Tasli L, Tabak F, Ozturk R. Erythema nodosum: an evaluation of 100 cases. Clin Exp Rheumatol. 2007;25(4):563-70. Murray M. Encyclopedia of Nutritional Supplements. Rocklin, CA: Prima Publishing; 1996:320-335. Oresajo C, et al. Protective effects of a topical antioxidant mixture containing vitamin C, ferulic acid, and phloretin against ultraviolet-induced photodamage on human skin. J Cosmet Dermatol. 2008;7(4):290-7. Ozcan H, Seyhan M, Yologlu S. Is metronidazole 0.75% gel effective in the treatment of seborrhoeic dermatitis?

A double-blind, placebo controlled study. Eur J Dermatol. 2001;17(4):313-6. Passarini B, Infusino SD. Erythema nodosum. G Ital Dematol Venereol. 2013;148(4):413-7. Requena L, Sanchez Yus E. Erythema Nodosum. Dermatologic Clinics. 2008;26(4). Reuter J, Jocher A, Hornstein S, Monting JS, Schempp CM. Sage extract rich in phenolic diterpenes inhibits ultraviolet-induced erythema in vivo. Planta Med. 2007;73(11):1190-1. Reuter J, Jocher A, Stump J, Grossjohann B, Franke G, Schempp CM. Investigation of the anti-inflammatory potential of Aloe vera gel (97.5%) in the ultraviolet erythema test. Skin Pharmacol Physiol. 2008;21(2):106-10.

Schwartz R, Nervi S. Erythema Nodosum: A Sign of Systemic Disease. Am Fam Phys. 2007;75(5). Sies H, Stahl W. Nutritional protection against skin damage from sunlight. Annu Rev Nutr. 2004;24:173-200. Review. Sinclair SA, Reynolds NJ. Necrolytic migratory erythema and zinc deficiency. Br J Dermatol. 1997;136(5):783-785. Stahl W, Heinrich U, Jungmann H, Sies H, Tronnier H. Carotenoids and carotenoids plus vitamin E protect against ultraviolet light-induced erythema in humans. Am J Clin Nutr. 2000;71(3):795-798. Stern RS. Improving the outcome of patients with toxic epidermal necrolysis and Stevens-Johnson syndrome. Arch Dermatol. 2000;136(3):410-411.

Stupica D, Lusa L, Ruzic-Sabljic E, Cerar T, Strle F. Treatment of erythema migrans with doxycycline for 10 days versus 15 days. Clin Infect Dis. 2012;55(3):343-50. Taylor SC, Averyhart AN, Heath CR. Postprocedural wound-healing efficacy following removal of dermatosis papulosa nigra lesions in an African American population: a comparison of a skin protectant ointment and a topical antibiotic. J Am Acad Dermatol. 2011;64(3 Suppl):S30-5. Vickers AJ. Independent replication of pre-clinical research in homoeopathy: a systematic review. Forsch Komplementarmed. 1999;6(6):311-320. Webb AR, Engelsen O. Ultraviolet exposure scenarios: risks of erythema from recommendations on cutaneous vitamin D synthesis. Adv Ex Med Biol. 2014;810:406-22.

Alternative Names Erythema Nodosum: Symptoms, Causes, Diagnosis, and Treatment Erythema Nodosum How is erythema nodosum treated? What is erythema nodosum? Erythema nodosum is a type of skin inflammation that is located in a part of the fatty layer of skin. Erythema nodosum results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees . The tender lumps, or nodules, of erythema nodosum range in size from a dime to a quarter. They may be inflamed off and on for a period of weeks, then shrink and become flat, leaving a bruised appearance. Erythema nodosum can go away on its own in three to six weeks. After it's gone, it may leave only a temporary bruised appearance or a chronic indentation in the skin where the fatty layer has been injured. Chronic erythema nodosum is a condition in which lesions pop up elsewhere, for a period of weeks to months. However, chronic erythema nodosum that may last for years is another pattern.

Chronic erythema nodosum, with occasional recurrences, can occur with or without an underlying disease present. What causes erythema nodosum? Erythema nodosum may occur with or without another medical condition. Conditions that are linked with erythema nodosum include medications (sulfa-related drugs, birth control pills , estrogens ), strep throat , Cat scratch disease , fungal diseases, infectious mononucleosis , sarcoidosis , Behcet's disease, inflammatory bowel diseases ( Crohn's disease and ulcerative colitis ), and normal pregnancy . How is erythema nodosum diagnosed? The doctor would first do a physical exam of the rash . However, a biopsy - a procedure in which a small section of affected skin is taken to examine more thoroughly -- is usually required to confirm a diagnosis of erythema nodosum. How is erythema nodosum treated? Erythema nodosum is initially managed by identifying and treating any underlying condition, along with the skin lesions. Treatments for erythema nodosum include anti-inflammatory drugs, and cortisone by mouth or injection. Colchicine is sometime used effectively to reduce inflammation .

Treatment must be customized for the particular patient and his or her symptoms. It is important to note that erythema nodosum, while annoying and often painful, does not threaten internal organs and the long-term outlook is generally very good. WebMD Medical Reference from MedicineNet Reviewed by Debra Jaliman, MD on November 17, 2015 Sources Lyme disease | DermNet New Zealand DermNet New Zealand Author: Vanessa Ngan, Staff Writer, 2003. Updated by Dr Daniela Vanousova, Dermatologist, Czech Republic, March 2015. What is Lyme disease? Lyme disease is an infection caused by borrelia, a type of bacteria called a spirochaete. Lyme disease can affect any part of the body, most commonly skin, central nervous system, joints, heart, rarely eyes and liver. Lyme disease is common in parts of the United States (particularly in Massachusetts) and in Europe, but is reported from many areas of the world. In New Zealand, cases have only been reported in people that have recently travelled from an endemic area. Lyme disease is also called Lyme borreliosis. What are the subtypes of Lyme disease?

There are different types of borrelia in each continent resulting in different forms of Lyme disease in North America and Europe. In North America, the infection is due to the subspecies B burgdorferi sensu stricto and most often presents as: Erythema migrans Lyme arthritis In Europe, the infection is due to the subspecies B burgdorferi sensu stricto, B afzelii and B garinii, and most often presents as: Erythema migrans Acrodermatitis chronica atrophicans (due to B afzelii) Lyme neuroborreliosis How do you catch borrelia infection? Humans and animals are infected with the bacteria through hard-tick bites. The borrelia bacteria survive in the midgut of the ticks. The immature nymphs are most likely to transmit the infection. The ticks feed on infected animals and then on humans. Ticks occur in high grass, brush, woodland and leafy forest. The main hosts for the ticks and borrelia are small to medium-sized animals in Europe and deer in North America.

In North America, the tick vectors are Ixodes scapularis, I pacificus, and 4 other tick species In Europe and Asia, the tick vectors are I ricinus, I hexagonus, and I persulcatus Who gets Lyme disease? Lyme disease can affect children and adults. Infection most often occurs in forestry workers and in those who have been enjoying recreational activities in areas where ticks reside. What happens after a tick bite? Ticks can attach and feed in any part of the human body. The bite is painless. Because they are very tiny (just 2 mm in size) nymph bites are often overlooked. Borrelia are transmitted from the midgut of the infected tick to the attached skin when attachment lasts for 36–48 hours. Several things can happen after being bitten by an infected tick. The body's defence mechanisms can overwhelm and eliminate the infecting bacteria. The bacteria can remain localised at the site of the bite and cause a localised skin infection. The bacteria may disseminate via the blood and lymphatic system to other organs and cause a multisystem inflammatory disease. Erythema chronicum migrans What are the signs and symptoms?

The disease can basically be divided into 3 stages according to the extent of infection.

Stage 3–33 days after tick bite Erythema migrans 'Flu-like illness with low-grade fever, chills, fatigue and joint pain Borelial lymphocytoma – red to blue patch on the earlobe, nipple or scrotum, (common in childrem) Early disseminated Lyme disease Days to weeks after tick bite Multiple eythema migrans, smaller than initial patch Early neuroborreliosis Facial or Bell palsy – one sided paralysis of the facial muscles (common in children) Aseptic meningitis – fever, severe headaches and neck stiffness Polyradiculitis – numbness and pain in arms or legs Other cranial nerve palsies, mild encephalitis, peripheral neuritis Arthritis – painful and swollen large joints (knee is the most affected join) Carditis – abnormal heart rate Progression is gradual over months to years Progression is gradual over months to years Late Lyme disease Chronic Lyme arthritis (chronic severe joint pain and swelling) in one or more large joints, mostly knee (more common in North America than in Europe) Chronic neurological disorders such: Disorientation, confusion, dizziness, lack of concentration, short-term memory loss Shooting pain, numbness extending to hands/arms

 and feet/legs Erythema migrans Erythema migrans, a red expanding patch of skin, is the most typical sign of Lyme disease and is present in 70–80% of cases.

It usually appears 7–14 days (range 3–33 days) after the infected tick bite. It starts at the site of the tick bite as a red papule or macule that gradually expands. The size of the rash can reach several dozens of centimetres in diameter. A central spot surrounded by clear skin that is in turn ringed by an expanding red rash (like a bull's-eye) is the most typical appearance. Erythema migrans may also present as a uniform erythematous patch or red patch with central hardening and blistering. The redness can vary from pink to very intensive purple. Erythema migrans is mostly asymptomatic, but can be itchy, sensitive or warm if touched. It is rarely painful. Fatigue, chills, headache, low-grade fever, muscle and joint pain, may occur briefly and then recur if the disease progresses. Lymph glands near the tick bite may be swollen. Erythema migrans disappears spontaneouslly within 3–4 weeks. If left untreated the disease may disseminate, affect other organs, and progress to the next stage.

Diagnosis of Lyme disease It is important to get early diagnosis if you think you may have Lyme disease. Diagnosis can be made on the presence of erythema migrans and other symptoms, plus a history of or evidence of a tick bite. Laboratory tests are usually not necessary in the early stage of erythema migrans, Undetected or ignored early symptoms may be followed by more severe symptoms weeks, months or even years after the initial infection. Certain laboratory tests are then recommended to confirm diagnosis and should be interpreted by an expert.. Antibody titres to B burgdorferi using enzyme-linked immunoassay (ELISA) or immunofluorescent assay. Positive results should be confirmed by Western immunoblot Acrodermatitis chronica atrophicans The organism can be cultured and/or polymerase chain reaction (PCR) test for the organism can be done on the skin specimen Positive antibodies to B. burgdorferi can be in many cases detected for many years after the successful treatment. Tick bites may transmit other infections like tick-born encephalitis, anaplasmosis and babesiosis.

Co-infections should be considered if symptoms of Lyme disease are severe or prolonged, in case of high fever, and abnormal blood tests results (leucopaenia, thrombocytopenia, elevation of liver transaminases). What treatment is available for Lyme disease? Localised or early Lyme disease generally responds well to appropriate antibiotics. Full cure is usually achieved if the disease is diagnosed and treated promptly, but the cure rate decreases the longer treatment is delayed. The choice of antibiotic depends on bacterial sensitivity. Antibiotics used include, doxycycline , amoxicillin, cefuroxime, azithromycin, erythromycin , intravenous penicillin and cetriaxone. The route of administration and the duration of antibiotic course depends on the stage and organ involvement. It varies between 10 and 30 days. Late stage Lyme disease, especially neuroborreliosis, should be treated with intravenous antibiotics. Some patients have persistent or recurrent symptoms of unknown origin after apparently successful antibiotic treatment for Lyme disease. This is called post-treatment Lyme borreliosis syndrome. It is believed to be an auto-immune response. Prolonged antibiotic treatment does not improve cure rates.

Prevention of Lyme disease Avoid areas endemic for Lyme borreliosis. When walking in high grass or woodland, wear white clothes (so the tick can be seen more easily) with long sleeves, long trousers tucked into socks, or long boots. Use repellents/pesticides. After return from a walk in an endemic area, change your clothes and check your whole body carefully. The next day, check your body for ticks again. Remove the tick as a prompt removal decreases the risk of Lyme disease transmission. Disinfect the site. Use tweezers to carefully and steadily pull the tick out from the skin. Disinfect the site again. Wash your hands. Watch the site of the tick bite for several weeks. If a rash appears bigger than 5 cm or you have 'flu-like symptoms, consult your doctor. There is no vaccine for Lyme disease. Related information References: Textbook of Dermatology. Ed Rook A, Wilkinson DS, Ebling FJB, Champion RH, Burton JL. Fourth edition. Blackwell Scientific Publications.

On DermNet NZ: Erythema nodosum | definition of erythema nodosum by Medical dictionary Erythema nodosum | definition of erythema nodosum by Medical dictionary Related to erythema nodosum: erythema multiforme , sarcoidosis Erythema Nodosum Definition Erythema nodosum is a skin disorder characterized by painful red nodules appearing mostly on the shins. Description Erythema nodosum is an eruption of tender red lumps on both shins and occasionally the arms and face. Bruising often accompanies the nodule formation. Erythema nodosum is most prevalent in young adults. Causes and symptoms Erythema nodosum can be caused by many important and treatable diseases. Among them are tuberculosis , several fungal lung infections, leprosy , inflammatory bowel disease, and some potentially dangerous bacterial infections. Drugs can also induce erythema nodosum. The most common are penicillin, sulfonamides , and birth control pills. Diagnosis There are a few other skin eruptions that mimic erythema nodosum, so the physician may have to perform a biopsy to sort them out.

There are a few types of panniculitis, fat inflammation, that may signal a cancer somewhere in the body, and there are other kinds of inflammation that may confuse the diagnosis. Once the skin problem has been diagnosed, its underlying cause must then be identified. A lengthy evaluation may ensue, and often times the cause remains unknown. Treatment Painful nodules can be treated with mild pain killers and local application of ice packs. Medical attention will be directed toward the underlying disease. The nodules will eventually disappear, leaving no trace behind. Resources Books Bennett, J. Claude, and Fred Plum, editors. Cecil Textbook of Medicine. Philadelphia: W. B. Saunders Co., 1996. Key terms Biopsy — Surgical removal of tissue for diagnostic purposes. Panniculitis — Inflammation of fatty tissue. erythema [er″ĭ-the´mah] redness of the skin caused by congestion of the capillaries in the lower layers of the skin. It occurs with any skin injury, infection, or inflammation.

erythema chro´nicum mi´grans a ring-shaped erythema due to the bite of a tick of the genus Ixodes; it begins as an erythematous plaque several weeks after the bite and spreads peripherally with central clearing. Often there are also systemic symptoms, including chills, fever, headache, vomiting, backache, and stiff neck. See also lyme disease. gyrate erythema (erythema gyra´tum) erythema multiforme characterized by the development of lesions that tend to migrate and spread peripherally with central clearing. erythema ab ig´ne permanent erythema produced by prolonged exposure to excessive nonburning heat. It is seen most often on the legs of women, but under appropriate environmental circumstances, it can occur anywhere on the body in either sex. erythema indura´tum a chronic necrotizing vasculitis, usually occurring on the calves of young women; see also bazin's disease .

erythema infectio´sum a mild, self-limiting disease of childhood characterized by a lacelike skin rash symmetrically distributed on the hands, arms, and legs, with few or no other symptoms; occasionally there is a low grade fever, and the condition often clears up without specific treatment. The incubation period is six days to two weeks. This disease is contagious and originally was believed to be a form of rubella; because the rash can resemble that of scarlet fever and German measles, it is important to differentiate this mild condition from those more serious ones. Called also fifth disease . erythema margina´tum a type of erythema multiforme in which the reddened areas are disk-shaped, with elevated edges. erythema margina´tum rheuma´ticum a superficial, often asymptomatic, form of gyrate erythema associated with some cases of rheumatic fever, which is characterized by the presence on the trunk and extensor surfaces of the extremities of a transient eruption of flat to slightly indurated, nonscaling, and usually multiple lesions.

Synonym(s): nodal fever erythema nodosum a hypersensitivity reaction characterized by reddened, tender subcutaneous nodules on the extensor aspects of the extremities, such as the shins. The nodules last for several days or weeks, never ulcerate, and are often associated with mild fever, malaise, and pain in muscles and joints. This condition may accompany streptococcal infections, tuberculosis, sarcoidosis, drug sensitivity, ulcerative colitis, and pregnancy. The prognosis is good with appropriate treatment of the underlying condition. A course of corticosteroids is usually effective in diminishing the symptoms. Erythema nodosum erythema nodosum A nodular, erythematous eruption of acute onset, which is usually confined to the anterior and lateral lower legs (but also affects the arms, face and trunk), and is regarded as a delayed hypersensitivity reaction. While it usually resolves spontaneously, it may be chronic. Clinical findings Warm and tender nodules, bruise-like colours, bilateral, symmetrical, fever, and joint pain.

Demographics More common in young (age 18–35) women (female:male ratio, 4:1); incidence is 25 cases/100,000/year. Associations Infections (especially streptococcus, but also cat-scratch disease), coccidiodomycosis, psittacosis, yersiniosis, sarcoid, inflammatory bowel disease, drugs (e.g., sulphonamides, halides, gold, sulfonylurea, oral contraceptives), lymphoma, oestrogen, neutrophilic dermatosis (Sweet syndrome, Behçet disease). NSAIDs, wet compresses, elevation, bed rest. Erythema nodosum vs. nodular vasculitis: Ulceration: No vs.

Yes er·y·the·ma no·do·sum (er'i-thē'mă nō-dō'sŭm) A panniculitis marked by the sudden formation of painful nodes on the extensor surfaces of the lower extremities, with lesions that are self limiting but tend to recur; associated with arthralgia and fever; may be the result of drug sensitivity or associated with sarcoidosis and various infections. Deep biopsies show a septal panniculitis (i.e., inflammation of fatty connective tissue), with infiltration by lymphocytes and scattered multinucleated giant cells. erythema nodosum Inflammation of small blood vessels (vasculitis) causing red, raised, tender nodules under the skin of both shins and sometimes elsewhere on the body. These disappear after some days or weeks. There may be fever, aches and pains and sickness. Erythema nodosum is an immunological disorder associated with a variety of conditions including TUBERCULOSIS , SARCOIDOSIS , streptococcal infections, drug allergies and LEPROSY .

erythema nodosum dermatosis associated with drug sensitivity, sarcoidosis or infection; characterized by sudden onset, rapid, self-limiting (but recurrent) formation of lesions on leg extensor surfaces, sometimes with arthralgia and fever erythema redness of the skin caused by congestion of the capillaries in the lower layers of the skin. It occurs with any skin injury, infection or inflammation. erythema ab igne Erythema Marginatum - Pictures, Symptoms, Treatment, Causes Treatment What is Erythema Marginatum? Erythema marginatum is a rare skin condition characterized by the onset of pink or reddish rings in the trunks and the inner regions of the limbs. These rings are primarily observed on the surfaces of the extensor muscles. It is a distinctive rash that appears and disappears periodically which may last for months. Erythema marginatum is neither a disease nor a disorder but rather a symptom signifying the existence of an underlying condition that triggered the attack. This uncommon skin condition is divided into two types and the following are: Erythema marginatum rheumaticum This is the asymptomatic form of erythema marginatum that is superficial in occurrence.

This type is usually associated with rheumatic fever and is also considered as a type of gyrate erythema and has no known etiology. The multiple skin eruptions can be seen dispersed all over the trunk and on the skin surface of the limbs. Erythema marginatum perstans This is the type of erythema marginatum that exhibit skin lesions distributed all over the skin surface of both the legs and the arms. The lesion can also spread to the other areas of the body except in the palm of the hands and soles of the feet. Erythema marginatum perstans may also affect the deep layer of the skin and the onset is believed to be associated with an existing underlying condition. The incidence of erythema marginatum is prevalent in light skinned individuals and is rather hidden or difficult to observe in dark skinned people. It can affect people of all ages including children and is twice common in male gender than in female. Some percentage of rheumatic fever cases are also being linked or associated with erythema marginatum. Erythema Marginatum Symptoms The onset of erythema marginatum is represented by macular rings with pale center or a similar appearance to a doughnut.

The circular fashion of the macula has rough edges signifying the slow development as revealed in the appearance of the rings. The lesions may be elevated or flushed while the core of the ring is small and flattened. The core of the ring is clear while the rash is spreading peripherally to adjacent areas. The rash or the circular rings assume a pinkish to reddish color with the core that is pale or clear. The rash can occur in multiple areas of the body but cannot appear on the face, palms of the hands and soles of the feet. The pinkish or reddish rings have various sizes that range from 0.5cm to 8cm in diameter. The rings will spread and increase in size overtime and will tend to have an irregular shape or may have an indented margin. The initial onset is on the lower trunk then slowly extends in an upper direction. The rash on the lower part disintegrates as it extends upward where it becomes more apparent. Erythema marginatum is generally non-pruritic that no irritation and itchy sensation can be experienced. The rash however can be aggravated by body temperature where it gets worse during hot shower or extreme heat in the weather.

The aggravation is characterized by reddish discoloration where it disintegrates as soon as the body temperature is back to normal. Causes Erythema marginatum has no clear or definite etiology. The sudden alteration in the epidermal layer of the skin is the result of inflammation in the blood vessels is prompted by the lymphocytes histiocytes. The exact cause of the alteration of the epidermal layer of the skin in erythema marginatum has not been clearly identified. There are several factors however that are being considered to trigger the onset of erythema marginatum and the following are: Rheumatic fever Rheumatic fever is often associated with erythema marginatum. It is an inflammatory disease caused by group A streptococcus bacterial infection. This inflammatory disease is prevalent in children with ages from 5 to 15 years although can also occur in adults. Erythema marginatum is among the clinical features of Rheumatic fever and the rash is non-pruritic and generally not painful. The onset of rash can go unnoticed and usually fades then reappear within hours that may persist for weeks or months.

Rheumatic fever is also regarded as the most common cause of erythema marginatum as revealed in most cases reported. Advertisement Lyme disease Lyme disease also results to erythema marginatum as among its symptoms. It is an infectious disease caused by Borrelia burgdorferi and is prevalent in North America. It is a tick-borne disease that is transmitted to humans through bites from infected ticks of the genus of Ixodes. Allergy Allergic reaction towards a wide range of stimuli can trigger the onset of rash as its response to the stimuli. This could include food ingested, exposure to chemical agents, and environmental exposures. The allergic food reaction is the most common trigger of rash particularly in blue cheese and tomatoes. Malignancy Malignancy is also one factor considered for the onset or erythema marginatum. Life-threatening diseases and disorders such as leukemia, lymphoma, breast cancer and squamous cell carcinoma are among the considered triggers of erythema marginatum. Infection Infection from a broad spectrum of causative agents can result to small eruptions. Escherichia coli, Ascaris lumbricoides and Candida albicans are among the infectious agent known to elicit the rash of erythema marginatum.

Adverse reaction Adverse reaction to certain drugs used for medication can also elicit the rash eruption. Pharmacological drugs such as penicillin, antimalarial chloroquine or hydrocychloroquine and cimetidine are being linked to the activation of erythema marginatum in some cases. Hormones A hormonal change is another factor being considered in erythema marginatum as seen in pregnant women. The onset of puberty is activated by hormonal changes thus explains the onset of erythema in children aged 15 years or those already in their puberty stage. Erythema marginatum during pregnancy usually resolve right after delivery. Treatment Erythema marginatum is not a primary disease but rather a symptom of a number of disorders that treatment directed towards the rash is not necessary. The rash usually resolves on its own even without treatment although they tend to linger for weeks, months and even a year. Rheumatic fever is the most common cause of erythema marginatum that treating the underlying condition is necessary to prevent medical complications that may arise from erythema marginatum as the condition if can result to an inflammation in the heart which is potentially life-threatening. Withdrawal from drugs and any other medication that can aggravate the rash is necessary.

Food that can elicit allergic reaction should be avoided to prevent the onset of erythema marginatum while those that are caused by an infection can be managed with antibiotic treatment to eradicate the infection. Erythema Marginatum Pictures Panniculitis - NHS Choices Panniculitis Print this page Introduction Panniculitis is a broad term refering to inflammation of the fatty layer underneath the skin. It's usually seen in women, on the thighs and lower legs. There are many types of panniculitis – with different causes – but the condition generally causes the skin to feel hard and to develop painful red lumps (nodules) or patches (plaques), making it look darker in places. Panniculitis usually affects the shins and calves, but may spread to the thighs, forearms and chest. It tends to clear up within six weeks, fading like a bruise, usually without scarring. When the inflammation has settled, a depression in the skin may be left, which can be temporary or permanent. Many people get recurring bouts of panniculitis. Other symptoms As well as skin symptoms, panniculitis may also be associated with: fever joint pain What are the causes?

There are a wide range of possible causes of panniculitis, although often the cause is not known. Common causes include: an infection – usually a viral or bacterial infection, but sometimes tuberculosis an inflammatory disease such as Crohn’s disease or ulcerative colitis some medicines, including the oral contraceptive pill or sulphonamides (a group of antibiotics ) sarcoidosis – a rare disease that causes body cells to form into clumps, called granulomas, in the lungs and skin leukaemia (cancer of the white blood cells) or lymphoma (cancer of the lymphatic system, part of your immune system) Some cases of panniculitis may be caused by the body's immune system mistakenly attacking the fat cells. Types of panniculitis The layer of fat underneath the skin is made of lobules (groups of fat cells) held together by connective tissue. Doctors sometimes classify the disease as either: ‘mostly septal’ – the inflammation mostly affects the connective tissue ‘mostly lobular’ – it mostly affects the fat lobules Some people will also have vasculitis, where the immune system attacks the body's blood vessels.

If a blood vessel is inflamed, it can narrow or close off, this can limit, or even prevent, blood flow through the vessel and potentially damage organs. The most common type of panniculitis is erythema nodosum, which affects the shins. In about half of all cases of erythema nodosum, the cause is unknown. A similar form of the disease is Weber-Christian disease, also known as idiopathic lobular panniculitis (idiopathic means ‘unknown cause’). This most commonly affects the thighs and lower legs of women aged 30-60, and can also cause the non-skin symptoms mentioned above, such as fever and fatigue.

Other types include: erythema induratum (nodular vasculitis), which usually affects the calves of young women and is often caused by tuberculosis cold panniculitis, which affects areas of skin exposed to the cold – for example, it can affect the cheeks and forehead of infants and children subcutaneous sarcoidosis, when the cause is the rare disease sarcoidosis A full list of all the different types of panniculitis can be found on DermNet NZ , which provides pictures and detailed information on the specific types. How is panniculitis treated? Doctors will aim to treat the underlying cause of the panniculitis, if known, and relieve some of the symptoms. While treatment is underway, you will be asked to ensure you get enough rest and to elevate the affected area when possible. Treatments will vary; for example, if panniculitis is triggered by medication, this medicine should be stopped – but don't stop taking any medication without first speaking to your GP. If the cause is a bacterial infection, you will be prescribed anti-inflammatory antibiotics, such as tetracycline, to clear the infection.

If the cause is sarcoidosis, you may not need any medical treatment as the disease often goes away on its own with time (usually a couple of years). Often, simple lifestyle changes, over the counter painkillers, and support bandages are all that is needed to control any flare ups. Read more about managing sarcoidosis . The following treatments may help to relieve symptoms: Joint pain and painful skin nodules can be relieved with anti-inflammatory painkillers ( NSAIDs ), such as ibuprofen. A solution of potassium iodide may help to relieve symptoms – this is thought to have an effect on white blood cells (read more about potassium iodide treatment for skin conditions ). The inflammation may occasionally be treated with steroid cream , steroid tablets or injections , or immunosuppressants (drugs to weaken the immune system), if the immune system is responsible. If the condition is severe and the above treatments don't help, you may wish to consider surgical removal of particularly bad patches of skin. Your GP will refer you to a dermatologist (skin specialist) to discuss the pros and cons of surgery. How does liver disease affect the body? - Liver Disease - Sharecare How does liver disease affect the body?

Topics | Digestive Health | Liver Disease | How does liver disease affect the body? A Answers (1) A Honor Society of Nursing (STTI) answered The liver has many functions, so liver disease can affect the body in many ways. Some effects include jaundice, a yellowing of the skin and whites of the eyes, which caused by high levels of bile pigment. Liver disease may cause people to itch, have high blood pressure, have a decreased number of red or white blood cells, and have reduced brain function. Liver disease may also cause hormonal changes in men and women. Additionally, people with liver disease may have little appetite and undergo weight loss. Helpful? 3 people found this helpful. This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs. Videos (6) Albinism Albinism Understanding Albinism Humans, animals, and even plants can have albinism, a condition that gives people a kind of pale appearance. But what is albinism and what causes it?

Albinism is a genetic condition where people are born without the usual pigment (color) in their bodies. Their bodies aren't able to make a normal amount of melanin, the chemical that is responsible for eye, skin, and hair color. So most people with albinism have very pale skin, hair, and eyes. Albinism can affect people of all races, and there are different kinds of albinism. Some people with a condition called oculocutaneous albinism have extremely pale skin and eyes, and white hair. Others with this same type of albinism might have slightly more color in their hair, eyes, or skin. For some people, albinism affects only their eyes. This is known as ocular albinism. People with ocular albinism usually have blue eyes. In some cases, the (the colored part of the eye) has very little color so a person's eyes might look pink or reddish. This is caused by the blood vessels inside the eye showing through the iris. In some forms of ocular albinism, the hearing nerves hearing may be affected and the person may develop hearing problems or deafness over time.

Except for eye problems, most people with albinism are just as healthy as anyone else. In very rare cases a person's albinism is part of another condition that involves other health problems in addition to albinism. People with these types of albinism can have such health complications as bleeding, lung, bowel, and immune system problems. continue Eyesight and Albinism People with albinism often have trouble with their eyesight. They may wear glasses or contact lenses to help correct problems like nearsightedness, farsightedness, or astigmatism. Others might need eye surgery. Just as there are different degrees of albinism there are also different levels of eye problems for a person who has the condition. Albinism does not make a person completely blind. Although some people with albinism are "legally blind," that doesn't mean they have lost their vision completely. They can still read and study — they just may need larger print or magnifiers to help them. People with albinism can be very sensitive to light because the iris doesn't have enough color to shield the properly. Wearing sunglasses or tinted contact lenses can help make them more comfortable out in the sun.

Skin Precautions Besides giving skin, eyes, and hair their color, melanin helps protect our skin from the sun. It does this by causing skin to tan instead of burn — which is why people with darker skin (more melanin) are less likely to burn than people with lighter skin. So people with albinism can sunburn very easily. People with light skin are also particularly at risk for skin cancer. So it's important for people with albinism to use a sunscreen with a high SPF factor at all times and to wear clothing that offers protection from the sun, such as hats, dark-colored clothing, or long pants and long-sleeved shirts. previous continue What Causes Albinism? Albinism is inherited. It's not contagious — you can't "catch" it from someone else. People are born with albinism because they inherit an albinism gene or genes from their parents. In the most common forms of oculocutaneous albinism, both parents must carry the albinism gene for a child to be born with the condition. Even if both parents carry the gene, the chance of each of their children being born with albinism is one in four.

If just one parent has the gene and the other parent has a normal pigment gene, their children won't have oculocutaneous albinism. But each child will have a one in two chance of being a "carrier" of an albinism gene. If a child who carries the gene grows up to have a baby with someone who also does, there's a one in four chance that their baby may have albinism. Since most people who carry an albinism gene don't show any signs of the condition, a baby with albinism can be born to parents whose coloring is typical for people of their ethnic group. The most common form of ocular albinism affects only males who have inherited an albinism gene from their mothers. Some females can have a milder form of the condition if they have inherited this gene. How Is It Treated? Because most people with albinism don't have health problems, treatment — apart from vision care — isn't usually necessary. But they do need to take certain precautions, such as wearing sunglasses and sunscreen when outdoors. Albinism can't be "cured." But it only rarely leads to serious health problems. When health problems are serious, doctors usually can treat the symptoms.

previous continue What's Life Like for Teens With Albinism? People with albinism are just like anyone else, with the same lifespan and ability to reach their goals. But living with any medical condition during the teen years can be difficult, and albinism is no exception. Because the social scene can be more about fitting in than standing out, teens with albinism may face bullying or prejudice. Voicing any frustration or sadness to a family member or friend who understands can help. So can talking to a counselor or therapist to get ideas on coping with the challenges that come up during the teen years.

Question: In humans, the condition erythema affects which part of the body?
Answer: Skin